Healthcare Provider Details

I. General information

NPI: 1265560379
Provider Name (Legal Business Name): GEORGIA PAIN INSTITUTE. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3356 VINEVILLE AVE
MACON GA
31204-2328
US

IV. Provider business mailing address

PO BOX 13474
MACON GA
31208-3474
US

V. Phone/Fax

Practice location:
  • Phone: 478-476-9886
  • Fax: 478-476-9976
Mailing address:
  • Phone: 478-476-9886
  • Fax: 478-476-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS J GIRON
Title or Position: CEO
Credential: M.D.
Phone: 478-476-9886